| NPI | 1528588787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: FL ME161696) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301113077) |
| 2085N0700X (Licence: MI 4301502711) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2026-07-10 |